Proefschrift Kerklaan

Evidence for the use of PN in the PICU

While the evidence from high quality RCTs no longer supports the early use of PN for critically ill adult patients, and while the literature may suggest the opposite for preterm newborns, there is currently no evidence to support any of the current PN practices for critically ill patients from term neonates to adolescents. Although several observational studies of large cohorts of critically children have shown a relation between the adequacy of feeding and of protein intake during the first 10 days of admission and lower risk of death 4,41 , the adult literature calls for caution in assuming that this association is causal. Hence, whether and for how long the substantial macronutrient deficit that accumulates in critically ill infants and children on enteral feeding only can be tolerated remains an open question. Further research is therefore necessary to address this question and to determine the role of PN in the PICU population. In order to answer this important question, the study should be large enough to have enough statistical power to detect relevant differences in hard clinical endpoints. The results of the currently ongoing multicenter randomized controlled PEPaNIC trial (Clinical Trials.gov NCT 01536275), will hopefully elucidate some of the controversial topics. The PEPaNIC trial is a study of 1440 critically ill infants and children, and compares the effects of early PN with no PN for up to one week in PICU on several patient-centered clinical endpoints such as new infections and the duration of PICU dependency, besides safety endpoints including mortality 42 .

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